Media Wiki - User contributions [en]

Increase Access to Overdose Reversal Medications

2020-02-20T17:18:43Z

John.fritsche:

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Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map or]] [[ZOOM_MAP_-_Expand_Harm_Reduction_Practices_Associated_with_Opioid_Misuse|Zoom Map (Expand Harm Reduction Practices Associated with Opioid Misuse)]] or [[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|ZOOM MAP - Improve Access to Treatment that ]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|Prevent]][[ZOOM_Map-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths| Overdose Deaths]]

= Naloxone (Narcan) =

[[Additional_Info_on_Naloxone|Naloxone]] (Narcan) is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent an opioid user’s breathing and heart rates from slowing to fatal levels. Beginning in 2016, thirty-five states have made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. Many other states are now working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation. It is either injected or administered in a nasal spray.<br/> <br/> While [[Additional_Info_on_Naloxone|Naloxone]] is not readily available by ordinary citizens, it can be easily administered with little or no formal training. State laws have made it difficult for citizens to obtain the life-saving medication, due to third-party prescription and prescription via standing order policies. The third party-prescription law prohibits the prescription of drugs to a third party other than whom the drugs will be given to, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. Although, the drug could potentially save more lives if more widely distributed, there is fear of bystanders not summoning medical assistance due to possible prosecution against them.<br/> <br/> According to a report by CADCA, a small community in Connecticut has made training for first responders to an overdose mandatory. Officers found a man in an unconscious state and realized he was overdosing. With the administration of Narcan, the man was able to recover from the overdose and regain consciousness.<br/> <br/> Narcan has the potential to be very beneficial in communities with a high opioid problem. Making a community aware of it's existence, and it's power to reverse overdose is a benefit unlike any other. Narcan will allow victims of abuse to be more likely to survive an overdose when first responders are rightly prepared. This medicine is one of need if a community is struggling with an opioid problem.<br/> It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help.<sup class="reference">[1]</sup><br/>  

== Evidence of Effectiveness ==

There is some evidence that opioid overdose education and naloxone distribution programs increase knowledge of appropriate overdose response among participating opioid users and others likely to encounter an overdose situation. Naloxone distribution through such programs is associated with reduced overdose deaths and appears to increase participant's confidence in their ability to respond effectively to overdose situations. However, additional evidence is needed to confirm effects.

  Communities that implement programs to train potential bystanders to identify an opioid overdose and respond with naloxone appear to reduce opioid overdose death rates more than communities that do not implement such programs.

  Family and friends of opioid users have greater knowledge of opioid overdose and ability to respond appropriately after receiving training in naloxone administration than peers who learn about opioid overdose and naloxone via na information booklet. Current or former opioid users who have received training in overdose response appear to identify overdose and recognize conditions when naloxone is appropriate as accurately as medical experts. Some studies suggest that opioid users who have participated in only a brief 5-10 minute training or learned naloxone administration through social networks can respond appropriately to an overdose.

  Training first responders such as police, firefighters, and EMTs to administer naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in naloxone administration adn overdose training report increases in knowledge and confidence in managing opioid overdose emergencies after program completion.

  A recent study in Massachusetts found that cities that have naloxone distribution programs have [http://www.bmj.com/content/346/bmj.f174 lower overdose death] rates than those that don’t. Similarly, the [http://www.nchrc.org/programs-and-services/ North Carolina Harm Reduction Coalition] has given out 52,000 naloxone kits since 2013 through their statewide grass roots network that includes syringe exchange and naloxone distribution, with more than 8,700 overdose reversals reported.<br/> [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose CADCA: Narcan Awareness]<sup class="reference">[2]</sup><br/>  

= Educate about Dangers of Dual use =

In 2013 there were 23,153 opioid overdose deaths -- 16,235 involving opioid painkillers, 8,260 involving heroin/opium, and at least 1,342 involving a combination of the two. However, opioid overdoses are seldom due to opioid use along; the majority are a result of mixing an opioid with some other drug. The best way to avoid opioid overdose is not taking opioids; the next best thing is to avoid drug mixing entirely. If you insist on mixing drugs in spite of the inherent dangers, then it is imperative to take extra safety precautions to not die when mixing drugs.<br/>   These include:

 

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*Have Narcan on hand
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong

<br/> Narcan only works on opioids, but doesn't harm an individual in the case on non-opioid overdose. So if there's any question as to what a person took, use narcan; it can only help.<sup class="reference">[6]</sup><br/>  

= Waive Copays =

Many people who are prescribed Narcan (nearly 35%) don’t pick it up—presumably because they can’t afford the co-pay.<sup class="reference">[7]</sup><br/>   Having insurers eliminate the co-pay is one strategy to help address that. [https://www.aetna.com/index.html?cid=ppc-700000001035216-National_Always%20On_Branded_Aetna_Exact-Aetna-aetna&s_dfa=1&gclid=Cj0KCQiA38jRBRCQARIsACEqIeuilyQ_mSIjuCUt394XAuPY7X7VLnJ16hmHFgFYPcLvvOwo4NUwmxkaAsEhEALw_wcB&gclsrc=aw.ds Aetna] is currently the first national payer to waive copays for Narcan for its fully-insured commercial members. This will "increase access and remove possible financial barriers to the lifesaving drug."<sup class="reference">[8]</sup><br/>  

 

= Legislation & Policy =

== Good Samaritan Laws ==

People often hesitate to seek treatment or call medical assistance in fear of incarceration or other form of punishment. In August of 2015, the White House announced a treatment-based initiative with $2.5 million going toward a pilot program that will engage law enforcement officers and public health professional to collect data on the movement of heroin along the East coast, and to train first responders on when it is adequate to administer Naloxone.<sup class="reference">[9]</sup>

  In 2006, New Mexico passed a [http://www.nytimes.com/2007/04/05/us/05drugs.html "Good Samaritan Law"] that "granted limited immunity from prosecution on simple possession chargers for people who dialed 911 to report a drug overdose". By 2015, 28 states in addition to the District of Columbia had passed similar laws.

  In Minnesota, a "Good Samaritan" law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removes a potential barrier--fear of arrest--that sometimes leads to help not being called and lives being lost to overdose.<sup class="reference">[10]</sup>

 [http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx Drug Overdose Immunity and Good Samaritan Laws] for minimizing the fears of calling for help in the case of an overdose.<br/>  

 
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== Increasing Awareness of Law ==

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.<sup class="reference">[11]</sup><br/> [http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf University of Washington study]
*After New York state passed its Good Samaritan law in 2011, for example, the Drug Policy Alliance printed 1 million cards and posters that explained the law and offered basic instructions on how to initially respond to an overdose, and worked with various agencies to help distribute these materials to vulnerable populations.<br/> [http://www.drugpolicy.org/sites/default/files/documents/DPA_911_GoodSam_Wallet_Card_v10_PRINTABLE.PDF Example Cards]<br/> [http://www.drugpolicy.org/sites/default/files/documents/DPA_911_Good_Samaritan_Flyer_EN_v3.pdf Example Posters]
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== Federal Changes to Address Problem ==

Various federal organizations came together to encourage good faith prescription of naloxone to ordinary citizens and the second was to encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

 

== State Law Passage ==

By the end of 2016, all but 3 states, Kansas, Montana, and Wyoming, have passed laws to improve ordinary person naloxone access.<br/>  

 

== Pharmacists ==

In California, The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone (Narcan) without a prescription in case of emergencies.<sup class="reference">[12]</sup>

 
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= New in 2016: Improved Access to Nasal Narcan =
New Public Interest Pricing $37.50 per dose <div class="objectEmbed">[[Media:Press_Release_for_Adapt_Pharma_and_Public_Interest_Pricing.pdf|Press Release for Adapt Pharma and Public Interest Pricing.pdf]]  (230 KB)</div> <br/> Free case of Narcan Nasal for any school. (Only 9 states allow as of Jan 2016). <div class="objectEmbed"><div>[[Media:Free_Narcan_Nasal_Spray_and_Education_for_High_Schools.pdf|Free Narcan Nasal Spray and Education for High Schools.pdf]]  (164 KB)</div> </div> </div>
= Law Enforcement Use of Naloxone =

*A 2016 report by the Police Executive Research Forum provides case examples of law enforcement naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), Camden County (CJ), Mongomery County (MD), and Hagerstown (MD) including descriptions of training, funding, administration and support.<sup class="reference">[13]</sup>

 

*[[EI_-_Librarians_&_Access_to_Overdose_Treatment|EI - Librarians & Access to Overdose Treatment]] The Bureau of Justice Assistance (BJA) maintains an online toolkit featuring resources and information on naloxone, including a section on liability and risk for law enforcement officers and their employers associated with naloxone administration.<sup class="reference">[14]</sup>

 

= Database of State Legislative Efforts =

This [http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx site] has many examples of policy efforts that have been attempted or passed.

 

=== Prevent Overdose strategies ===

This [https://www.overdosepreventionstrategies.org/ link] is a resource that has put every state's strategy into an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This will allow for communities to enter and see what works and what does not.

 [https://www.overdosepreventionstrategies.org/ Overdose Prevention Strategies]<br/>  

 

= Engaging Diverse Community Partners =

[[CP_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|CP - Improve Access to Treatments that Prevent Overdose Deaths]]

= Tools & Resources =

[[TR_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|TR - Improve Access to Treatment that Prevent Overdose Deaths]]<br/> [http:///file/view/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf/613626145/SAMHSA_Opioid_Overdose_Prevention_TOOLKIT.pdf SAMHSA- Opioid Overdose Prevention Toolkit] - In particular, sections Facts for Community Members and Information for Prescribers may be of special interest.

= Scorecard Building =

[[PO_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Potential Objective Details]]<br/> [[PM_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Potential Measures and Data Sources]]

= Actions to Take =

[[PA_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Coalitions]]

[[PAI_-_Improve_Access_to_Treatment_that_Prevent_Overdose_Deaths|Actions for Individuals]]

= Resources to Investigate =

[[RTI_-_Improve_Access_to_Treatments_that_Prevent_Overdose_Deaths|More RTI on Enhancing Access to Emergency Treatments]]<br/> <br/> '''PAGE MANAGER''': [insert name here]<br/> '''SUBJECT MATTER EXPERT''': [fill out table below]

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= Sources =

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#Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.
#CACDA Administration of Narcan. 2017  [http://www.cadca.org/resources/coalition-action-meriden-healthy-youth-coalition-mhyc-provides-life-saving-overdose [1]]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts [https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_]
#100 Million Healthier Lives City, Town-Wide, and Regional Efforts.[https://www.baltimorecountymd.gov/news/baltimorecountynow/Kamenetz_Announces_Significant_County_Substance_Abuse_Initiatives_ [2]]
#[http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/ http://www.rehabs.com/pro-talk-articles/the-ultimate-harm-reduction-guide-to-drug-mixing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/ https://news.aetna.com/2017/12/aetna-announces-new-policies-improve-access-narcan-combat-overprescribing/]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf http://www.minnesotarecovery.org/files/FINAL_Good_Samaritan_Postcard.pdf]
#[http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html]
#[http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf http://www.pharmacy.ca.gov/publications/naloxone_media_release.pdf]
#Police Executive Research Forum. 2016. Building Successful Partnerships between Law Enforcement and Public Health Agencies to Address Opioid Use. COPS Office Emerging Issues Forums. Washington, DC: Office of Community Oriented Policing Services.<br/> [https://ric-zai-inc.com/Publications/cops-p356-pub.pdf https://ric-zai-inc.com/Publications/cops-p356-pub.pdf]
#[https://www.bjatraining.org/tools/naloxone/Liability-and-Risk https://www.bjatraining.org/tools/naloxone/Liability-and-Risk]
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Expand & Enhance Chronic Pain Prevention & Management

2020-02-19T19:13:44Z

John.fritsche:

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Return to the  [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom Map (Reduce Prescription of Opioids]]) __TOC__

= Background =

*Chronic pain occurs when pain last for longer than 3 months.<ref>[1] Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
</ref>
*Pain affects more Americans than diabetes, heart disease and cancer combined.<ref>[2]Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
</ref>
*25.3 million American adults suffer from daily pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref>
*23.4 million American adults report a lot of pain.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017.</ref>
*14.4 million American adults suffer the highest level of pain, category 4.<ref>Nahin, Richard L. “Estimates of Pain Prevalence and Severity in Adults: United States, 2012.” The journal of pain : official journal of the American Pain Society 16.8 (2015): 769–780. PMC. Web. 27 Jan. 2017</ref>
*Today, chronic pain is the most common cause of long-term disability in the U.S.<ref>[6]Yesterday, Today & Tomorrow: NIH Research Timelines. (n.d.). Retrieved November 24, 2019, from https://archives.nih.gov/asites/report/09-09-2019/report.nih.gov/nihfactsheets/index.html
</ref>

Chronic Pain and Opioid Use Among Seniors

Chronic pain is the primary reason seniors are prescribed opioids -- and use of opioids has many negatives for seniors (great article)<ref>[7] How the Opioid Crisis Affects the Elderly | Updated for 2019. (2018, September 4). Retrieved November 24, 2019, from AgingInPlace.org website: https://www.aginginplace.org/how-the-opioid-crisis-affects-the-elderly/
</ref>

== Risk factors ==

for chronic pain include:

 

*genetics - heritability accounts for 38.4% of the variation in chronic pain risk<ref>[8] Genetic and environmental risk factors for chronic pain. (n.d.). Retrieved November 24, 2019, from ScienceDaily website: https://www.sciencedaily.com/releases/2016/08/160816151850.htm
</ref>
*female gender<sup class="reference"><ref>O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
*older age<sup class="reference"><ref>[9]Hecke, O. van, Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology and its clinical relevance. British Journal of Anaesthesia, 111(1), 13–18. https://doi.org/10.1093/bja/aet123
</ref></sup>
*race and ethnicity<sup class="reference"><ref>[10Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref></sup>
*being a military veteran<sup class="reference"><ref>[11]Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/</ref></sup>
*low socioeconomic status<sup class="reference"><ref>[12]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
*employment status and occupational factors<sup class="reference"><ref>[13]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
*history of abuse or interpersonal violence<sup class="reference"><ref>[14]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
*anxiety and depression<sup class="reference"><ref>[15]O. van Hecke, N. Torrance, B. H. Smith; Chronic pain epidemiology and its clinical relevance. Br J Anaesth 2013; 111 (1): 13-18. doi: 10.1093/bja/aet123</ref></sup>
*existing health problems - fibromyalgia, shingles, arthritis, a weakened immune system<sup class="reference"><ref>[16]Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
</ref></sup>
*lifestyle - not eating health, not exercising regularly, smoking, or having a drug or alcohol problem<sup class="reference"><ref>[17]Pain Management: Treatment Overview. (n.d.). Retrieved November 24, 2019, from WebMD website: https://www.webmd.com/pain-management/guide/pain-management-treatment-overview
</ref></sup>
*previous surgery<sup class="reference"><ref>[18]McGreevy, Kai, Michael M. Bottros, and Srinivasa N. Raja. “Preventing Chronic Pain Following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficacy.” European journal of pain supplements 5.2 (2011): 365–372. PMC. Web. 27 Jan. 2017.
</ref></sup>

 

== Managing Chronic Pain ==

*8 Million Americans are on long-term opioid therapy for chronic pain<sup class="reference"><ref>[19]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>
*1 million are taking dangerously high doses<sup class="reference"><ref>[20]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>
*The dilemma: how to provide the most effective pain treatment for 80 percent of pain patients who are at least risk for opioid addiction while causing the least harm to the remaining 20 percent who are at most risk of developing OUD<sup class="reference"><ref>[21]Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
</ref></sup>
*Experts say chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street<ref>[22]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
</ref>
*With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids<sup class="reference"><ref>[23]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>
*Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control<sup class="reference"><ref>[24]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet</ref></sup>

= Current Status =

Expanding and improving pain prevention programs is a hot topic among public health officials. In March 2016, the National Institute of Health released its National Pain Strategy that outlines the federal government's first coordinated plan to address America's pain crisis.<sup class="reference"><ref>[25]National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref></sup> One of the cornerstones of the strategy is the prevention of chronic pain.<ref>[26]National Pain Strategy Overview | Interagency Pain Research Coordinating Committee. (n.d.). Retrieved November 24, 2019, from https://www.iprcc.nih.gov/National-Pain-Strategy/Overview</ref>

= Promising Programs =

== Avoiding Illness and Injury ==

Workplace injury and illness prevention programs at both establishment and corporate levels are effective in transforming workplace culture; leading to reductions in injuries, illnesses and fatalities and lowering workers' compensation and other costs<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">.<sup class="reference"><ref>[27]Injury and Illness Prevention Programs—Frequently Asked Questions. (n.d.). Retrieved November 24, 2019, from https://www.osha.gov/dsg/InjuryIllnessPreventionProgramsWhitePaper.html
</ref></sup></span><br/>  

<span style="font-family: Tahoma; font-size: 12.8px;">Educational Programs</span>

*<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Back Pain - Don't Take It Lying Down (Australia) - a 3 year campaign in Australia in the late 1990s that used mass media and other methods to promote several evidence-based concepts about back pain. <sup class="reference"><ref>[28]Buchbinder R. Can we change a population’s perspective on pain? In: Croft P, Blyth FM, van der Windt D, editors. Chronic pain epidemiology: From aetiology to public health. Oxford, England: Oxford University Press; 2010. pp. 329–344.</ref></sup> </span>
**<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Outcome: "Dramatic improvements in what the public and clinicians believed about back pain, accompanied by a decline in related workers’ compensation claims and health care utilization during the campaign; those beliefs have persisted over time."<sup class="reference"><ref>[29]Institute of Medicine (US) Committee on Advancing Pain Research, C. (2011). Pain as a Public Health Challenge. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92516/
</ref></sup></span>

 

== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Behavior Change Programs</span> ==

<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #ff0000; font-family: Tahoma; font-size: 12.8px">[need examples]</span></span></span><br/>  

== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Pain Self Management Programs</span> ==

<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #090909; font-family: Tahoma; font-size: 12.8px">[[MyStrength|myStrength]] is an example of a promising pain management program.</span></span></span><br/>  

== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Private Facebook Group</span> ==

<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Clare Rhodes runs a private Facebook group for chronic pain patients.<sup class="reference"><ref>[30]Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet. (2017, November 21). Bloomberg.Com. Retrieved from https://www.bloomberg.com/news/articles/2017-11-21/millions-of-patients-face-pain-and-withdrawal-as-opioid-prescriptions-plummet
</ref></sup></span></span></span><br/>  

== <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">The DiscovEHR Project</span></span></span> ==

<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">A researcher from Florida Atlantic University's Charles E. Schmidt College of Medicine has received a five-year, $4 million grant from the National Institutes of Health to help solve the "one-size-fits-all" approach to prescribing opioids for chronic pain. Because of the high heritability, finding the genetic predictors of prescription opioid use disorder is more critical than ever. Currently, little data exists on clinical characteristics and genetic variants that confer risk for opioid use disorder.</span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">In the novel study, researchers will assess clinical and genetic characteristics of a large patient cohort suffering from chronic musculoskeletal pain and receiving prescription opioids. As part of the project, researchers will leverage data from Geisinger's central biorepository and electronic health record (EHR) database to conduct large-scale genomics research and phenotype development.</span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">With the genetic information, the multidisciplinary team will derive a clinical and genetic profile of prescription opioid-use disorder and apply the knowledge to develop an "addiction risk score." Researchers hope the findings from this study will enable clinicians to identify those who are at low-risk for opioid use disorder from those who are at high-risk and require additional counseling and access to alternative treatment options.</span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">The genome-wide association study will help the researchers determine if there is a particular subset of genes and genetic variants that are influencing susceptibility to becoming addicted to prescription opioids. Once they are able to generate the hypothesis that a genetic variant is responsible for increasing risk, the next steps will involve proving causation. Ultimately, the researchers hope their work will be used to help empower patients so that they understand their susceptibility to risks and can make informed health care decisions.<ref> [31]Genetic study defies “one-size-fits-all” approach to prescribing opioids for chronic pain. (n.d.). Retrieved November 24, 2019, from https://medicalxpress.com/news/2017-12-genetic-defies-one-size-fits-all-approach-opioids.html
</ref></span></span></span></span></span></span><br/>  

= Tools & Resources =

[[TR_-_Expand_&_Enhance_Chronic_Pain_Prevention_&_Management|TR - Expand & Enhance Chronic Pain Prevention]]

= Resources to Investigate =

<span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">[[RTI_-_Expand_&_Enhance_Prevention_of_Chronic_Pain_&_Management|RTI Expand & Enhance Chronic Pain Prevention]]</span></span></span></span><br/> <br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span></span></span></span></span><br/> <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></span></span></span></span></span></span></span></span></span></span>

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| <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">'''Comments'''</span></span></span></span></span></span>
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= <span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px"><span style="background-color: #ffffff; font-family: Tahoma; font-size: 12.8px">Sources</span></span></span></span></span></span> =

 
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</div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2020-02-19T18:44:17Z

John.fritsche:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">
'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

----

(PDMP) allows pre-registered users including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards to access timely patient controlled substance history information.<sup class="reference"><ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref></sup><br/> <br/> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<sup class="reference"><ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup>

= Background =

== The Purpose of PDMPs ==

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at a state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<sup class="reference"><ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref></sup>

<br/> PDMPs can alert Healthcare Providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<sup class="reference"><ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref></sup>
*They DO NOT dismiss patients from care

<br/> With this in mind, states are trying to find ways to increase use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<sup class="reference"><ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref></sup><br/>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

__TOC__

== Examples of Positive Impact ==

*Between the years of 2010-2012 Florida implemented a PDMP and other "pill mill" policies that had an positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<sup class="reference"><ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref></sup> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<sup class="reference"><ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref></sup>
*New York Experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<sup class="reference"><ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<sup class="reference"><ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<sup class="reference"><ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<sup class="reference"><ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></sup></div> <div class="_"> </div>
== Legislation ==
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <sup class="reference"><ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref></sup><br/> <br/> Opportunities to Enhance PDMPs</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center ]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<sup class="reference"><ref>[17] Can't find the source ( Error 525)</ref></sup> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.<sup class="reference"><ref>[18]Can't find source ( error 525) https://guidemed.com/about-guidemed/</ref></sup>

== Provider Challenges to Effective Use of PDMPs ==

*<u>Insufficient Resources:</u> Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "it's too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*<u>Patient Provider Relationship:</u> The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*<u>Data Management:</u> There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*<u>Consistency:</u> Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<sup class="reference"><ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref></sup>

<br/> '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<sup class="reference"><ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from : chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2Fprograms%2Fpmixarchitecture.pdf</ref></sup>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [http://www.namsdl.org/prescription-monitoring-programs.cfm model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual summaries or highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneaous Documents

= State PDMPs =

#<span style="background-color: #ffffff">[https://oag.ca.gov/cures CURES ]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]</span>
#<span style="background-color: #ffffff">[http://www.orhealthleadershipcouncil.org/our-current-initiatives/emergency-department-information-exchange-edie EDIE ]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as patient visits ER.</span>
#<span style="background-color: #ffffff">[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE ]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of it's [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources ].</span>
#<span style="background-color: #ffffff">[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via user name and password.</span>
#<span style="color: #fa1048">[http://www.worxpdmp.com/ WORx]</span><span style="background-color: #ffffff">Wyoming's active PDMP system.</span>

 

== Find Your State's PDMP ==
<div class="_">Use this [http://mytopcare.org/resources/using-the-state-prescription-monitoring-program-pmp-effectively/find-your-states-pmp/ link] to find your state's Prescription Drug Monitoring Program.</div> <div class="_">
= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=http%3A%2F%2Fwww.pdmpassist.org%2Fpdf%2FPDMP_Funding_Options_TAG.pdf</ref>
*see the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions.<br/> <br/> <u>The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program</u> is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<sup class="reference"><ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref></sup> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals due April 25, 2017.<sup class="reference"><ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup><br/> <br/> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects<br/> Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders.The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program will be applied by April 25, 2017.<sup class="reference"><ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup>
</div> <div class="_"> </div>
= Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]]<br/> <br/> The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

= Resources to Investigate =

[[RTI_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|More Resources to Investigate on PDMP Use and Impact]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

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= Sources =

 
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]

Expand & Enhance Prescription Drug Monitoring Program (PDMP)

2020-02-19T16:31:54Z

John.fritsche:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">
'''''Return to '''[[ZOOM_MAP_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|Zoom Map (Expand & Enhance PDMP) ]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]] or [[ZOOM_MAP_-_Minimize_Diversion_of_Prescription_Drugs|Zoom Map (Minimize Diversion of Prescription Drugs)]] or [[ZOOM_MAP_-_Reduce_Prescription_of_Opioids|Zoom map - Reduce Prescription of Opioids]]''

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(PDMP) allows pre-registered users including licensed healthcare prescribers eligible to prescribe controlled substances, pharmacists authorized to dispense controlled substances, law enforcement, and regulatory boards to access timely patient controlled substance history information.<sup class="reference"><ref>[1]PDMP/CURES. (n.d.). Retrieved November 24, 2019, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/PDMP-CURES.html</ref></sup><br/> <br/> PDMPs are designed to collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. This information is used to assist prescribers, dispensers, and other health care professionals in making clinical decisions for their patients. PDMPs also have been shown to reduce adverse drug interactions, and help health care professionals identify patients who may be in need of substance use treatment. Law enforcement and regulatory/licensing board officials utilize PDMP information, under appropriate circumstances, to further their investigations of suspected violations of controlled substance laws and compliance with regulatory/licensing board practice standards. Many states have also begun to use PDMPs as a public health surveillance tool. PDMPs continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.<sup class="reference"><ref>[2]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup>

= Background =

== The Purpose of PDMPs ==

The main objectives of PDMP programs are to:

*Improve patient safety.
*Build a data collection and analysis system at a state level.
*Enhance existing programs' ability to analyze and use collected data.
*Facilitate the exchange of collected prescription data among states.
*Assess the efficiency and effectiveness of the programs funded under this initiative.<sup class="reference"><ref>[3]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref></sup>

<br/> PDMPs can alert Healthcare Providers to provide potentially lifesaving information and interventions.

*They DO for those using prescription opioids
**Help collaborate with the patient to taper to a safer dosage
**Consider offering naloxone
**Communicate with other providers managing the patient
**Weigh patient goals, needs, risks
*They DO for those who they consider to have opioid use disorder, discuss safety concerns and treatment options<sup class="reference"><ref>[4]What Healthcare Providers Need to Know about PDMPs | Drug Overdose | CDC Injury Center. (2019, July 12). Retrieved November 24, 2019, from https://www.cdc.gov/drugoverdose/pdmp/providers.html</ref></sup>
*They DO NOT dismiss patients from care

<br/> With this in mind, states are trying to find ways to increase use of PDMPs by prescribers so they avoid having a mandate. In some states, you are automatically registered when practitioners apply for a license. There are also efforts to integrate PDMP data into electronic medical record systems so the information is available at the point of care.<sup class="reference"><ref>[5]How to monitor prescription drugs | Psychiatry & Behavioral Health Learning Network. (n.d.). Retrieved November 24, 2019, from https://www.psychcongress.com/article/how-monitor-prescription-drugs</ref></sup><br/>   [https://www.cdc.gov/drugoverdose/pdmp/ Prescription Drug Monitoring Programs]

__TOC__

== Examples of Positive Impact ==

*Between the years of 2010-2012 Florida implemented a PDMP and other "pill mill" policies that had an positive impact on the opioid epidemic. According to the CDC, Florida recorded a 26.1% decrease in opioid analgesic overdose deaths, after these policies were implemented.<sup class="reference"><ref>[6]Decline in Drug Overdose Deaths After State Policy Changes—Florida, 2010–2012. (n.d.). Retrieved November 24, 2019, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm</ref></sup> The Florida Department of Health said that from 2010 to 2013, oxycodone overdose deaths fell from 1,516 to 534—a 65% decrease.<sup class="reference"><ref>[7]Rutkow, L., Chang, H.-Y., Daubresse, M., Webster, D. W., Stuart, E. A., & Alexander, G. C. (2015). Effect of Florida’s Prescription Drug Monitoring Program and Pill Mill Laws on Opioid Prescribing and Use. JAMA Internal Medicine, 175(10), 1642–1649. https://doi.org/10.1001/jamainternmed.2015.3931</ref></sup>
*New York Experienced a 75% decrease in prescriptions issued through "doctor shopping" as a result of a 2012 requirement that prescribers check the PDMP before writing a prescription.<sup class="reference"><ref>[8]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup>
*74% of California physicians reportedly changed their prescribing practice as a result of patient activity reports created using the state's PDMP<sup class="reference"><ref>[9]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup>
*After establishing a PDMP, Tennessee saw a reduction in the morphine milligram equivalents dispensed, a reduction in the number of doctor and pharmacy shoppers going to multiple outlets to obtain drugs, an increase in queries to the State's Controlled Substance Monitoring Database Program by prescribers and extenders, and a change in practices, with some 41.4% less likely to prescribe certain controlled substances.<sup class="reference"><ref>[10]Do prescription drug monitoring programs work? | Insurance Fraud News Service. (n.d.). Retrieved November 24, 2019, from http://www.insurancefraud.org/IFNS-detail.htm?key=22343</ref></sup>

 

== Examples of Negative Impact ==
<div class="_">The existence of a Prescription Drug Monitoring Program within a state, however, '''appears to increase drug diversion activities in contiguous non-PDMP states'''. When states begin to monitor drugs, drug diversion activities tend to spill across boundaries to non-PDMP states. One example is provided by Kentucky, which shares a boundary with seven states, only two of which have PDMPs -- Indiana and Illinois. As drug diverters became aware of Kentucky PDMP's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states. OxyContin diversion problems have worsened in Tennessee, West Virginia, and Virginia -- all contiguous non-PDMP states -- because of the presence of Kentucky's PDMP, according to a joint federal, state, and local drug diversion report.<sup class="reference"><ref>[11]Diversion of Prescription Drugs. (n.d.). Retrieved November 24, 2019, from Drug War Facts website: https://www.drugwarfacts.org/chapter/diversion</ref></sup></div> <div class="_"> </div>
== Legislation ==
<div class="_">The Prescription Drug Monitoring Program was created by the FY 2002 U.S. Department of Justice Appropriations Act (Public Law 107-77). <sup class="reference"><ref>[12]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1
</ref></sup><br/> <br/> Opportunities to Enhance PDMPs</div>
== TTAC ==

[http://www.pdmpassist.org/ Training Technical Assistance Center ]: Brandeis University, in partnership with the Bureau of Justice Assistance, has developed the PDMP TTAC to provide services, support, resources and strategies to improve the effectiveness of state PDMPs. Call 781-609-7741 for more information.

== Third Party Patient Monitoring ==

'''GuideMed Monitoring''' is a management program for prescription narcotics monitoring. It helps provider networks prevent prescription drug misuse and it helps to protect the network and its practitioners from liabilities associated with prescription narcotics.<sup class="reference"><ref>[17] Can't find the source ( Error 525)</ref></sup> Patient service stations are established on-site or freestanding in locations determined by the physician, where GuideMed nurses will staff and manage the monitoring activities chosen by the physician (Risk Assessments, PDMP Checks, CSA Reviews, Pill Counts, Toxicology Testing). After the nurse gathers all the necessary information, a report is prepared and sent to the patient's physician via a PDF file attached to that patient's record. GuideMed also provides any data needed for a compliance officer.<sup class="reference"><ref>[18]Can't find source ( error 525) https://guidemed.com/about-guidemed/</ref></sup>

== Provider Challenges to Effective Use of PDMPs ==

*<u>Insufficient Resources:</u> Providers lack the time within their practice to perform all activities (not staffed sufficiently, not reimbursed, not value-added). Virtually every knowledge and use survey for PDMPs, for example, shows only half of physicians use the PDMP and the reasons cited for not using it are "it's too time consuming" and "its too difficult to use." ("I need to see a patient every 12 minutes to make ends meet, I do not have the time or capacity to do all of this work.")
*<u>Patient Provider Relationship:</u> The design of many programs tends to compromise the trust between patients and physicians because the providers are required to police their patients, and this is not something physicians see as part of their role as care providers. ("I did not go to medical school for this. I need a trusting relationship with the patient, which is not possible when I ask to count their pills.")
*<u>Data Management:</u> There is no automation support for any of this activity today, no field within the EMR to enter the risk-adjusted monitoring protocols or schedule patient activities according to risk levels, there is no place to store the results of a pill count or PDMP check or alert the physician when a treatment agreement needs to be updated.
*<u>Consistency:</u> Whether it is patients within a practice, practices within a network, or health systems within the state -- getting everyone to establish and adhere to protocols consistently is a challenge, yet inconsistent application of protocols is one of the greatest liabilities for any provider.<sup class="reference"><ref>[19]Preventing Chronic Opioid Therapy Addiction: PDMP’s alone are not the answer! | LinkedIn. (n.d.). Retrieved November 24, 2019, from https://www.linkedin.com/pulse/preventing-chronic-opioid-therapy-addiction-pdmps-alone-ron-frost/</ref></sup>

<br/> '''Prescription Drug Monitoring Information Exchange (PMIX)''' Architecture enables nationwide information sharing by the use of free, open, and consensus-based solutions; common formatting of shared data; security and privacy protocols to protect sensitive information; and preserving the state choice of interstate sharing solutions.<sup class="reference"><ref>[20]Prescription Drug Monitoring Programs: Critical Information Sharing Enabled by National Standards, Retrieved from : chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2Fprograms%2Fpmixarchitecture.pdf</ref></sup>

== Use PDMPs to Improve Patient Safety ==

== National Alliance for Model State Drug Laws ==
<div class="_">View [http://www.namsdl.org/prescription-monitoring-programs.cfm model PDMP laws ] and documents from states with prescription drug monitoring programs</div> <div class="_"> </div>
*Annual summaries or highlights
*Administration of PDMPs
*Data Reporting and Retention
*Types of Authorized Recipients
*Access and Registration
*PDMPs and Privacy
*Miscellaneaous Documents

= State PDMPs =

#<span style="background-color: #ffffff">[https://oag.ca.gov/cures CURES ]: California's state PDMP. Learn more at [https://oag.ca.gov/cures/faqs CURES FAQs]</span>
#<span style="background-color: #ffffff">[http://www.orhealthleadershipcouncil.org/our-current-initiatives/emergency-department-information-exchange-edie EDIE ]: Oregon and Washington use the Emergency Department Information Exchange (EDIE) system. This technology allows ED practicioners to identify patients with more than 5 ER visits in a one year period or those with complex care needs who can be directed to appropriate care. This system allows for alerts to hospitals as soon as patient visits ER.</span>
#<span style="background-color: #ffffff">[http://www.floridahealth.gov/statistics-and-data/e-forcse/ EFORSCE ]: Florida's PDMP. This database has been in effect since 2010 and there are [http://www.floridahealth.gov/statistics-and-data/e-forcse/news-reports/index.html annual reports ] for each year. The website also includes a list of it's [http://www.floridahealth.gov/statistics-and-data/e-forcse/funding/index.html funding sources ].</span>
#<span style="background-color: #ffffff">[https://pharmacypmp.az.gov/ Arizona State Board of Pharmacy Controlled Substances Prescription Monitoring Program (CSPMP) ]- Allows practitioners and pharmacists to look up, view, and print controlled substance dispensing information on their specific patients directly via user name and password.</span>
#<span style="color: #fa1048">[http://www.worxpdmp.com/ WORx]</span><span style="background-color: #ffffff">Wyoming's active PDMP system.</span>

 

== Find Your State's PDMP ==
<div class="_">Use this [http://mytopcare.org/resources/using-the-state-prescription-monitoring-program-pmp-effectively/find-your-states-pmp/ link] to find your state's Prescription Drug Monitoring Program.<br/>  </div> <div class="_"> </div>
= Innovative Use of PDMP Data =

== Notify the Care Team that Prescribed the Opioids of the Overdose Death ==
<div class="_">In Monterey County, CA, Coroners who identify that a person has died after misusing prescription opioids make use of data in the PDMP to identify and notify the care team that prescribed the opioids that their patient died. This seems to have had a big impact on prescribers and seems to have contributed to significant reductions in opioid prescription rates and increased use of non-opioid treatments for pain. (Need details and source.)</div> <div class="_">
= Funding Opportunities =

=== Current Funding Methods ===

*Federal grants
*Private/Non-federal grants
*General revenue funds
*Controlled substance registration fees
*Professional licensing fees
*Regulatory board funds

=== Potential Funding Methods ===

*PDMP licensing fees
*Health insurance licensing fees
*Private donations
*Medicaid fraud settlements
*Assessed fines
*Asset Forfeiture
*Drug manufacturers' assessment
*Prescription fees
*Private third party payers or health insurers
*PDMP authorized users<ref> [13]Technical Assistance Guide, No.04-13, Prescription Drug Monitoring Program Training and Technical Assistance Center, Brandeis University, July 3, 2013. Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=http%3A%2F%2Fwww.pdmpassist.org%2Fpdf%2FPDMP_Funding_Options_TAG.pdf</ref>
*see the PDMP TTAC Funding Options for Prescription Drug Monitoring Programs in [[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|Tools and Resources for]] full descriptions.<br/> <br/> <u>The Comprehensive Opioid Abuse Program Training and Technical Assistance (TTA) Program</u> is a grant from the U.S. Bureau of Justice given to state, local, and tribal governments to provide resources to intervene with persons with substance use disorders.<sup class="reference"><ref>[14]Bureau of Justice Assistance—Comprehensive Opioid Abuse Program (COAP). (n.d.). Retrieved November 24, 2019, from https://www.bja.gov/ProgramDetails.aspx?Program_ID=72#horizontalTab1</ref></sup> The goals of the Comprehensive Opioid Abuse TTA Program are twofold. First, the program aims to support site-based and state initiatives designed to reduce opioid misuse and the number of overdose fatalities. Second, the program supports PDMPs and their stakeholders in expanding the implementation, enhancement, and proactive use of prescription drug monitoring programs to support clinical decision-making and prevent the misuse and diversion of controlled substances. Proposals due April 25, 2017.<sup class="reference"><ref>[15]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup><br/> <br/> The Comprehensive Opioid Abuse Site-based Program - Harold Rogers Prescription Drug Monitoring Program Implementation and Enhancement Projects<br/> Funding opportunity which provides state, local, and tribal governments resources to intervene with persons with substance use disorders.The Harold Rogers Prescription Drug Monitoring Program (PDMP) is being incorporated into the FY 2017 Comprehensive Opioid Abuse Site-based Program. The purpose of this program is to improve collaboration and strategic decision-making of regulatory and law enforcement agencies and public health officials to address prescription drug and opioid misuse, save lives, and reduce crime. This is made possible through the collection and analysis of controlled substance prescription data and other scheduled chemical products through a centralized database administered by an authorized state agency. This program will be applied by April 25, 2017.<sup class="reference"><ref>[16]Comprehensive Opioid Abuse Site-based Program FY 2017 Competitive Grant Announcement, U.S. Department Of Justice, Office of Justice Programs, Bureau of Justice Assistance, Retrieved from chrome-extension://cdonnmffkdaoajfknoeeecmchibpmkmg/assets/pdf/web/viewer.html?file=https%3A%2F%2Fwww.bja.gov%2FFunding%2FCARA17.pdf</ref></sup>
</div> <div class="_"> </div>
= Tools & Resources =

[[TR_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Programs|TR - Expand & Enhance Prescription Drug Monitoring Programs]]<br/> <br/> The Pew Charitable Trust created a report on [http://www.pewtrusts.org/en/research-and-analysis/reports/2016/12/prescription-drug-monitoring-programs Evidence-Based Practices to Optimize Use of PDMPs]

= Resources to Investigate =

[[RTI_-_Expand_&_Enhance_Prescription_Drug_Monitoring_Program|More Resources to Investigate on PDMP Use and Impact]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

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</div> </div> </div> </div> </div> </div> </div> </div> </div> </div>
[[Category:SAFE-Prescriptions and Medical Response]]

Expand Prescription Drug Take-back & Disposal Program

2020-02-19T16:30:24Z

John.fritsche:

<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">
''Return to [[ZOOM_MAP_-_Reduce_Diversion_of_Prescription_Drugs|Reduce Diversion of Prescription Drugs]]''

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Most opioid abuse prevention strategies include some sort of prescription drug take-back or disposal program.  This is a step in the right direction, but most communities have significant opportunities to expand and enhance these efforts to reach more people and reduce the ability of people to misuse these medications or give them to others who may misuse them.  This objective focuses on practical ways to make improvements to existing efforts and to add new options that communities may not yet be doing. 

= Background =

== Why Safe Disposal is Important ==

'''Intentional Misuse''':

*A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.<sup class="reference">[2]</sup>
*SAMHSA’s 2009 National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet.
*Getting hooked on prescription opioids is directly responsible for over 60% of subsequent heroin addictions as addicts turn to this less expensive alternative.
*Prescription drugs involved in overdoses are almost all originally prescribed by physicians but were used by others who were not prescribed those drugs. (Get sources for this.) 

'''Accidental Exposure''':

*When medicines are no longer needed or have expired, it is important to properly dispose of them to reduce harm from accidental exposure or intentional misuse.<sup class="reference">[1]</sup> Throwing drugs in the garbage also is a bad idea, because they can accidentally be taken by kids or pets.

'''Environmental Concerns''':

*Some people propose flushing or pouring unused medications down the drain, however medications flushed into the waste stream can end up in water supplies.<sup class="reference">[3]</sup>
*Since the drugs in take-back programs are incinerated, take-back programs are the safest way to get rid of the chemicals and to stop them from getting into drinking water and watersheds as well as in the hands of those at risk.
*Innovative mail-back options provide a convenient way for people to have excess medications disposed of through incineration. (Details further down on this page.)

== Costs and Benefits of Safe Disposal Options ==

This fact sheet from the Product Stewardship Institute provides a good summary of the costs and benefits of different drug take-back and disposal options. 

[https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/gotoguide/drug_take-back_costs_fact_sh.pdf]
</div> <div class="mw-parser-output">
== To Flush or Not to Flush ==

If no take-back programs are readily available, it is still important to dispose of the medications quickly and appropriately. Some prescriptions include instructions on how to dispose of the drug.<sup class="reference">[5]</sup> The [https://www.fda.gov U.S. Food & Drug Administration (FDA)] provides the safest ways of disposing of these medications at home [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm here]. The FDA also recommends that certain drugs be flushed immediately such as fentanyl patches, Oxycontin, and Percocet. A full list can be found on [http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List this ]page.  Others experts strongly recommend <u>'''not'''</u> flushing medications down the toilet.<ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref>

The bottom line is that the best options are bringing your medications to a take-back day, putting them into a drug disposal kiosk, or using a mail-based program to send in the medications for proper disposal.  But, if you don't have access to these options, flushing unused medications that are on the "flush list" is better than keeping them around. <br/>  
</div>
= Special Populations =

== Senior Citizens ==

Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.  The Colorado Consortium for Prescription Drug Abuse Prevention has developed a successful program for reachng people age 65+ called "You're the Solution." This campaign has techniques and materials that can be used around the country. 

Learn more about [[You're_the_Solution|You're_the_Solution]] 

 

== Nursing Homes ==

Individual patients aside, one study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed.<sup class="reference">[6]   </sup>

Nursing homes could be provided with information and tools (or services) for more appropriate disposal options that are better for the environemnt and that minimize the likelihood of diversion of these medications.

== Hospice Programs or Funeral Home Programs ==

Hospice programs can help family members understand how to properly handle the medications they inherit when a loved one passes away.<sup class="reference">[7]</sup>

Funeral Homes may pass out a brochure to remind people to make sure that any prescription drugs that were being taken by a loved one are properly disposed of.  People in the late stages of life may have been getting prescription opioids to deal with pain.  Hospice and funeral homes could be provided with disposal products (like Seal&Send envelopes)

= Take-back Events =

== DEA National Drug Take-Back Day Initiative ==

<span style="background-color: #ffffff">The National Prescription Drug Take Back Day Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. As of May 2017, the DEA has promoted 13 national take-back days and they continue to collect more and more drugs each time. <sup class="reference">[8]</sup><br/> <br/> <span style="background-color: #ffffff">'''[https://www.deadiversion.usdoj.gov/drug_disposal/takeback/newsrelease.htm Program Successes]'''</span></span>

*<span style="background-color: #ffffff">Over 4,200 law enforcement and community partners and 5,500 sites across the country.</span>
*<span style="background-color: #ffffff">Since September 2010, these events have altogether collected 8,103,363 pounds (4,052 tons) of prescription drugs.</span>
*<span style="background-color: #ffffff">The last National Take-back Day collected more than 900,386 pounds (450 tons).</span>

<span style="background-color: #ffffff"><span style="background-color: #ffffff">To promote your local Rx Take Back Day, the DEA provides a [https://www.dea.gov/take-back/takeback-day_2016_oct.html partnership toolkit] featuring promotional materials for associated partners.<sup class="reference">[9]</sup><br/> <br/> <span style="background-color: #ffffff">'''<span style="font-size: 15.6px">See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more DEA take-back resources and other ideas on how to implement a local take-back day.</span>'''</span></span></span>

== <span style="background-color: #ffffff"><span style="background-color: #ffffff">State Level Drug Take Back Programs</span></span> ==

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">See below for inspiration and ideas to replicate from current state efforts:</span></span></span>

*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs Pennsylvania]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.in.gov/bitterpill/ Indiana]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx Oregon]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.artakeback.org/index.html Arkansas]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.takebackyourmeds.org/ Washington]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://stoprxabuseinga.org/ Georgia]</span></span>

= <span style="background-color: #ffffff"><span style="background-color: #ffffff">Local Disposal Drop Boxes</span></span> =
<div class="mw-parser-output">
== <span style="background-color: #ffffff"><span style="background-color: #ffffff">Finding Disposal Locations</span></span> ==

=== <span style="background-color: #ffffff"><span style="background-color: #ffffff">Medication Disposal Locators</span></span> ===

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Use the following links to find drug disposal locations</span></span></span>

*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1 DEA's Disposal Locator] - Find locations in your ZIP code. These collectors are registered with the DEA and pass unused medicine on to the agency to disposed.<sup class="reference">[10]</sup></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://rxdrugdropbox.org/ Rx Drop Box]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://disposemymeds.org/ Dispose My Meds]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/ National Association of Boards of Pharmacy]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.americanmedicinechest.com/ The American Medicine Chest Challenge]</span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://walgreens.maps.arcgis.com/apps/MapSeries/index.html?appid=53cf1b54abf34c4bacdec863e5c56391 Walgreens Safe Medication Disposal Program]</span></span>
</div> <div class="mw-parser-output">
== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Increasing the Number of Drug Drop-Boxes in your Community</span></span></span> ==

Since disposing of unneeded medications via a drug drop box is considered the best option, it is important for communities to increase the number of drop boxes that are available and to promote awareness of those drop boxes. 

Ths [https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/160920_PSI_Pharmacy_Guide_vS.pdf How-To Guide for Drug Take-Back] , created by the Product Stewardship Institute, provides detailed guidance for expanding and improving a pharmacy-based collection program. 

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The [http://www.rxdrugdropbox.org/ NADDI prescription drug dropbox ] website is an important resource to find locations of drop boxes, buy boxes, apply for grants, and other information about drop boxes.</span></span></span>
</div> <div class="mw-parser-output">
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">With the help of the of the [https://www.naddi.org/ National Association of Drug Diversion Investigators], communities can apply for grants to receive a drop box that will hold old opioids to prevent abuse. These boxes have resulted in multiple cities and communities to be safer, and reduce the risk of opioid addiction. Boxes are to be located in close proximity to law enforcement agencies so nothing happens to them. Multiple boxes have been placed in the State of Minnesota, and after reaching out to one town in specific, Fridley<sup class="reference">[11]</sup> , they told us that they have seen a positive response to the drop-box. They have discarded pounds of prescription opioids that came from an at-risk community.</span></span></span>
</div>
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">In-Home Disposal</span></span></span> =

== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Medication Mail-back Envelopes</span></span></span></span> ==

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Stericycle Prescription Drug Seal&Send Pouches</span></span></span></span>'''

Stericyle provides an option for unsed prescription drugs to be mailed to them in an unmarked mailing pouch, and then the pills are incinerated. 

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Learn more at: </span></span></span></span>[https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/ https://www.stericycleenvironmental.com/service/pharmaceutical-takeback/]

 

== In-home disposal pouches & powders ==

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Deterra Drug Disposal System </span></span></span></span>'''

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Minneapolis based company Verde Technologies has created a product called [http://deterrasystem.com/ Deterra®] System which deactivates prescription drugs.</span><br/> <br/> <span style="background-color: #ffffff">Each patented Deterra® pouch contains a water-soluble inner pod containing MAT12® activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches and liquids, allowing them to be adsorbed by the carbon, rendering them inert and non-retrievable.</span><br/> <br/> <span style="background-color: #ffffff">For more information on how to use Deterra®, view this [https://www.youtube.com/watch?v=lSBwBqpTk2c How-to video]</span></span></span></span></span><br/>  

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Current Efforts to Promote In-Home Disposal</span></span></span></span>'''
<div class="objectEmbed"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Case Studies</span></span></span></span></div>
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">The state of Pennsylvania has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions.</span></span></span></span></span>
<div class="objectEmbed"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Attorney General Shapiro Unveils Plan to Distribute 300,000 Drug Disposal Pouches in 12 counties[5]</span></span></span></span></span></div> <div class="objectEmbed">[https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html]</div>
<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Inspira Health Network (New Jersey) distributed the Deterra® pouch throughout their network.</span><br/> <span style="background-color: #ffffff">[http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study]</span></span></span></span></span> These pouches render opioids ineffective for misuse and safe for disposal and the environment, are another cost-efficient way to safely dispose of opioids.

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Benefits</span></span></span></span>'''

*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Inexpensive - Costs $7 per pouch</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Can encourage people to connect with law enforcement - People can pick up free (if already given to law enforcement) pouches from station and dispose of them at home and save any potential embarrassment</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Improve overall water quality - with the majority of people flushing unused medication down the toilet, only water treatment facilities remove less than half of the prescription drugs found in sewage</span></span></span></span>

'''<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">DisposeRx</span></span></span></span>'''

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://disposerx.com/ Dispose Rx] is "a patented (pending) blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Dedicated to environmentally friendly and safe non-toxic disposal solutions, DisposeRx is spearheading programs of educating communities with practical and safe medication disposing solutions, thus preventing the cycle of environmental pollution, addiction, overdose, and death." Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding powder from a packet directly into the pill bottle and shaking the bottle.</span></span></span></span></span>

*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Inexpensive - Costs about $1.50 per packet (and [https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html Walmart gives the packets away free with a prescription or possibly a request])</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Packets can attached to prescriptions with a rubber band (much like flower fertilizer is attached to fresh-cut flowers)</span></span></span></span>
*<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Well-suited to campaigns with community partners (like clinics, churches, barbershops or hair salons) to increase distribution to diverse populations.</span></span></span></span>

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">See [[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|Tools & Resources]] for more information.</span></span></span></span></span>

 
</div>
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Funding for Drug Takeback & Disposal</span></span></span></span> =

== <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Legislation & Drug Companies</span></span></span></span></span> ==

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Currently several West Coast counties, the city of San Francisco and the state of Massachusetts have issued legislature that require drug companies to fund drug take-back programs.<sup class="reference">[13]</sup> On a national level, however, only 2.5 percent of eligible take-back organizations are participating, according to the Government Accountability Office. <sup class="reference">[14]</sup> The primary barrier seems to be financial: Maintaining the safe-like prescription drop-off container, training staff to follow the relevant regulations, and destroying the returned medication costs money. As a potential solution, writing policy that mandates opioid manufacturers to pay patients for their returned bottles of pills, along with subsidizing drop off location operators, could offset the costs and be what is needed to make returning leftover medication an automatic habit for consumers. <sup class="reference">[15]</sup><br/> <br/> <span style="background-color: #ffffff">The [http://www.productstewardship.us/ Product Stewardship Institute], a nonprofit that supports drug take-back programs, calculated that at least a dozen other local governments around the country are considering similar legislation, including several California counties.</span><br/> <br/> <span style="background-color: #ffffff">In Minnesota, pharmaceutical company [http://www.mallinckrodt.com/ Mallinckrodt] donated 30,000 disposal pouch systems to be distributed.<sup class="reference">[16]</sup></span></span></span></span></span></span>

== State Legislation Requiring Disposal Kits be Given with Prescriptions ==

The Kentucky State Senate passed in March 2018 a bill that requires opioids and other abused drugs to be dispensed along with a method to permanently sequester and dispose of any leftover pills. If passed by the house and signed, it will be the first state passing such a bill.<sup class="reference">[4]  </sup>[http://www.disposerx.com DisposeRx] will be a popular choice to be given out along with prescription.  Other options include the Seal & Send mail-back packages or other options described below.

= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Tools & Resources</span></span></span></span></span></span> =

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[[TR_-_Expand_Prescription_Drug_Take-back_&_Disposal_Programs|TR - Expand Prescription Drug Take-back & Disposal Programs]]</span></span></span></span></span></span></span>
<div class="mw-parser-output">
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Actions to Take</span></span></span></span></span></span></span> =

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">There are many actions that can be taken by coalitions, organizations or individuals to improve drug take-back and disposal.  Explore the ideas via the following link:<br/> <span style="background-color: #ffffff">[[PA_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|Potential Actions for Coalitions]]</span></span></span></span></span></span></span>

[[PAI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Potential Actions for Individuals</span></span></span></span></span></span></span>]]
</div>
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Resources to Investigate</span></span></span></span></span></span> =

<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[[RTI_-_Expand_Prescription_Drug_Take-back_&_Disposal_Program|More RTI on Drug Take-Back & Disposal Program]]</span><br/> <br/> <span style="background-color: #ffffff"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span></span><br/> <span style="background-color: #ffffff"><span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span></span></span></span></span></span></span></span>

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| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Reviewer'''</span></span></span></span></span></span>
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Date'''</span></span></span></span></span></span>
| <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">'''Comments'''</span></span></span></span></span></span>
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<div class="mw-parser-output">
= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Sources</span></span></span></span></span></span> =

 

----

 

#[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm [1]]</span></span></span></span></span></span>
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [2]]</span></span></span></span></span></span>
#[http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/ http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts [3]]</span></span></span></span></span></span>
#<span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://disposerx.com/dl/Kentucky_Press_3-15_final.pdf [4]]</span></span></span></span></span></span>
#[https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm [5]]</span></span></span></span></span></span>
#[http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.XXVl6ehKhPZ] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.nbcnews.com/id/3077015/ns/health-health_care/t/got-old-medicine-dont-flush-it/#.WmEKDd-nGUk [6]]</span></span></span></span></span></span>
#[https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://www.dea.gov/divisions/hq/2017/hq050817a.shtml [7]</span></span></span></span></span>
#[https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://www.dea.gov/divisions/hq/2015/hq100115.shtml [8]]</span></span></span></span>
#[https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0 https://www.dea.gov/press-releases/2015/10/01/deas-prescription-drug-take-back-effort-big-success-0] <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm [9]]</span></span></span></span>
#[https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html https://www.hometownsource.com/sun_focus/news/local/drop-off-prescription-drugs-anonymously-at-fridley-pd/article_b07bd27d-1122-55fa-8465-f47ad9a861dc.html]  <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://focus.mnsun.com/2013/02/19/drop-off-prescription-drugs-anonymously-at-fridley-pd/ [10]]</span></span></span>
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] <span style="background-color: #ffffff"><span style="background-color: #ffffff">[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [11]]</span></span>
#[https://fortune.com/2016/04/30/big-pharma-drug-take-back/ https://fortune.com/2016/04/30/big-pharma-drug-take-back/] <span style="background-color: #ffffff">[http://fortune.com/2016/04/30/big-pharma-drug-take-back/ [12]]</span>
#[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/] <span style="background-color: #ffffff">[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/?utm_term=.e9ccd1f56650 [13]]</span>
#[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/ https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/]<span style="background-color: #ffffff">[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/?utm_term=.e9ccd1f56650 [14]]</span>
#[http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/] [http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/ [15]]
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[[Category:Pages with broken file links]] [[Category:SAFE-Prescriptions and Medical Response]]

Reduce Non-Medical Access to Prescription Drugs

2020-02-17T16:03:58Z

John.fritsche:

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''Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Reduce_Access_to_Opioids|Zoom Map (Reduce Access to Opioids)]]''

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To minimize diversion, it is essential that people who have prescription medications in their homes store them safely.  When people begin to misuse prescription drugs, they often acquire them by stealing them from family, relatives, friends or from homes that they enter for other reasons (work, open houses, breaking and entering).  If prescription drugs are safely stored, misuse can be stopped earlier, because people who have not yet developed a dependence on opioids usually do not go directly to illegal opioids like heroin or fentanyl.   __TOC__Prescription drugs that are not safely stored can also be accidentally taken by young children or by curious pre-teens.

= Background =

Safe storage of prescription drugs within the home has been identified as key priority strategy by many organizations and coalitions.<ref>https://www.end-opioid-epidemic.org/storage-and-disposal/</ref><ref>http://www.rxsafetymatters.org/families-and-communities/safe-storage-and-disposal/</ref>  Even if a community does an excellent job of reducing prescriptions and taking back or disposing of unused opioids, there will still be a lot of opioids in communities. Researchers estimated that in 2005, 3-4% of people were being prescribed opioids for chronic pain<ref>https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm</ref> <span style="font-size: 13px;">and many others are legitimately being prescribed opioids for short-term pain management, and many others who are prescribed other drugs that can be misused, stolen or accidentally consumed by children.</span>

Failure to securely store prescription drugs contributes to the opioid epidemic and other health hazards in several ways.

#Easy access to prescription drugs can lead to initial experimentation, especially by teens.<ref>http://makeitasafehome.org/the-problem/</ref>
#Stealing prescription drugs, which is much easier when they are commonly available in unlocked medicine cabinets, is often a step toward more destructive misuse.
#Easy access to unsecured opioids or other prescription drugs contributes to theft by people who sell them or give them away.
#Children who access unsecured drugs sometimes take them, thinking they are candy.

= Staggering Statistics =

*Only 2 in 10 who have dangerous medications—such as opioid pain pills, stimulants used to treat ADHD, and sedatives—lock them up
*Nearly 70% of prescription opioid medications kept in homes with children are not stored safely<ref>https://www.jhsph.edu/news/news-releases/2017/majority-of-opioid-medications-not-safely-stored-in-home-with-children-survey-finds.html</ref>
*A recent study of adults living in households with children, prescription opioids were stored in a locked or latched place in only 32.6% of households with young children and 11.7% with older children.<ref>https://pediatrics.aappublications.org/content/139/3/e20162161</ref>
*More than 1,600 teens begin abusing prescription drugs each day.<ref>http://www.rxsafetymatters.org/families-and-communities/facts-and-figures/</ref>
*Almost 1 in every 4 teens in America say they have misused or abused a prescription drug.<ref>http://www.rxsafetymatters.org/families-and-communities/facts-and-figures/</ref>
*60,000 kids under the age of 5 accidentally ingest these dangerous drugs every year and wind up in emergency rooms, according to data from the CDC<ref>http://www.consumerreports.org/drugs/best-ways-to-protect-kids-accidental-drug-poisoning-/</ref>
*12-17 year olds abuse prescription drugs more than ecstasy, heroin, crack/cocaine and methamphetamines combined.<ref>http://www.rxsafetymatters.org/families-and-communities/facts-and-figures/</ref>
*In one study, respondents reported storing their opioid medication in a locked (8.6%) or latched (20.9%) location.<ref>Kennedy-Hendricks A, et al. “Medication sharing, storage and disposal practices for opioid medications among US adults.” JAMA Intern Med 2016; 176:1027-29.</ref>
*San Diego's SafeHomes Coalition reports that more than 70% of misused prescription drugs come from someone's medicine cabinet, not from a dealer on the street. <ref>http://makeitasafehome.org/the-problem/</ref>
*The National Drug Intelligence Center reported that $184 million in prescription drug thefts occurred in 2010—a 350 percent increase since 2007<ref>https://www.nnw.org/publication/medication-theft-protecting-our-most-vulnerable-neighbors</ref>.  They note that older people are especially vulnerable to theft of prescription drugs.
*Over half of teens, ages 12 and up, obtained prescription drugs from a friend or family member "for free"

= Programs to Encourage Safe Storage and Reduce the Theft of Prescription Drugs =

== Examples of Campaigns and Organzations Supporting Safe Storage ==

'''Safe Homes Coalition'''<br/> [http://makeitasafehome.org/ SafeHomes Coalition] helps communities start programs to raise awareness of the proper use, storage and disposal of prescription drugs. (They can help your community start a chapter.) This [https://www.youtube.com/watch?v=m7C01hibtBg&feature=youtu.be SafeHomes PSA] provides more information.<br/> <br/> '''Up and Away Campaign'''<br/> This [http://www.upandaway.org/#about campaign] is designed to remind families about the importance of safe medicine storage. See [[TR_-_Improve_Safe_Storage_of_Prescription_Drugs|Tools & Resources]] for resources to distribute in your community.<br/>  

== Launching Community-wide Collaborative Campaigns ==

=== Drug Disposal and Safe Storage Campaign ===

Many communities have done some education and awareness efforts to increase prescription drug disposal and safe storage, but there is potential to reach significantly more people by engaging a diverse group of cross-sector partners in a campaign.

'''See Details:  '''[[Community_Safe_Storage_Campaign|Collaborative campaign to increase safe storage and prescription drug disposal]].<br/>  

=== Self-Funding Program for Safe Storage Caps (TimerCaps) ===

A local coalition, hospital, insurance company or non-profit can sponsor a program to distribute TimerCaps to people using prescription drugs. Sponsors have their logo imprinted on the cap and the label and can give them away at community events or via partners like pharmacists, community groups for seniors, or the prescribing doctors.

'''See Details:''' [[Details_for_a_Self-Funding_Safe_Storage_campaign|Self-Funding Safe Storage campaign]].<br/>  

'''Case Study of Successful Coalition Campaign with TimerCaps'''
South Kingston Program for Prevention and Rebels Inspiring Positive Lifestyles joined forces to raise funds to send youth leaders to CADCA training. The coalition held community awareness events and garnered local news publicity for their cause. For further details, see <div class="objectEmbed"> </div>
= Safe Storage Products =
<div class="_">Below are list of products that can either be distributed within your community or advertised by community coalitions for families to purchase.</div> <div class="_"> </div>
== TimerCaps ==

[[File:Orange-TimerCap.jpg|Orange-TimerCap.jpg]]<br/> [https://timercap.com/ TimerCap] has a built-in LCD stopwatch timer. Like a stopwatch, the display on the cap counts-up, first the seconds, then minutes and hours since the cap was replaced.<br/> Timer caps come in different sizes, and they can replace an existing medicine bottle cap (or you can get a cap and bottle combination). Using a TimerCap helps accomplish all [[Six_principles_of_prescription_abuse_prevention|six principles of prescription abuse prevention]]. TimerCaps are easy to use and don't require a change in patient behavior.<br/> <br/> '''Improve Patient Safety'''

*Provide the PEACE OF MIND of knowing they did or did not take their medication.
*Help seniors avoid accidental overdoses and emergency room visits due to accidentally taking medications multiple times.
*Easily know how long it has been since taking medication (to check before driving)
*Tracker form to help monitor their intake and pain levels or other information

<br/> '''Deter Theft of Pills'''

*Easily detect unwanted openings to the exact minute it happened
*Deters kids or neighbors from sneaking a few pills--as they would be caught by the new time
*Solution to measure, monitor, manage, detect,and deter opioids abuse.
<br/> '''Economical Enough to Give Away at Events or by Partners'''<br/> TimerCaps are a low-cost option for improving safe storage (as low as $2.49 each), so they are economical as a give-away at educational events, or they can be given to people by community partners. Since the TimerCap lids and labels can be customized with a logo or other branding information, sponsors who make donations to fund the program receive valuable recognition for their support. See coalition testimonials: <div class="objectEmbed">[[File/view/Testimonials.pages/628136277/Testimonials.pages|[File:http://www.wikispaces.com/i/mime/32/empty.png Testimonials.pages]]] <div>[[File/view/Testimonials.pages/628136277/Testimonials.pages|Testimonials.pages]]
*[[File/detail/Testimonials.pages|Details]]
*[[File/view/Testimonials.pages/628136277/Testimonials.pages|Download]]
*743 KB
</div> </div> <br/> <br/> Visit [http://www.timercap.com www.timercap.com] or Contact: 800-557-4072 ext. 106<br/>  
== Locking Storage Devices ==

'''Ikeyp'''<br/> [[File:Ikeyp Product.png|Ikeyp Product.png]]<br/> The world's first smart storage device for personal items that need to be securely stored yet regularly accessed. See [https://ikeyp.com/ website] for a comprehensive list of uses and products.<br/> Introductory video from a tech review: [https://vimeo.com/184531456 [1]]<br/> Gadgetgram Review including a video created by the manufacture of the product for CES 2018: [http://www.gadgetgram.com/2017/12/27/ikeyp-pro-smart-safe/ [2]]<br/> Retail price is $149.00 but a coordinated community-wide effort to promote safe storage of prescription drugs, bulk purchase discounts may be available.<br/> ''Contact for bulk purchasing'': 1-800-485-8904<br/> <br/> <span style="color: #67677e; font-size: 1.2em; letter-spacing: 0.5px">'''Lockable Caps'''</span><br/> '''Safer Lock'''<br/> [[File:Safer Lock Product.png|Safer Lock Product.png]]<br/> [https://saferlockrx.com/ Safer Lock] is a patented 4-digit combination locking cap. This could be purchased by communities at wholesale prices and distributed to community members at lower prices.<br/> <br/> Products:

#[https://saferlockrx.com/product/safer-lock/ Safer Lock]
#[https://saferlockrx.com/product/medication-lock-box/ Safer Lock Box]
#[https://saferlockrx.com/product/safer-lock-cases/ Safer Lock Multi-Packs & Case]s
#[https://saferlockrx.com/product/book-safe/ Book Safe]

<br/> ''Contact for wholesale pricing'': (844) 209-5044<br/>  

== Changing Drug Packaging ==

*Packaging opioid drugs in [https://en.wikipedia.org/wiki/Blister_pack blister packs] , or in single-dose packages, instead of having an entire bottle filled with prescription pills have been shown to help prevent accident poisonings in children<ref>http://www.livescience.com/58351-kids-opioids-ingestion.html</ref>
*One vendor of Single-dose packets is [https://pack4u.com/ Pack4U]. They provide a sophisticated, personalized option that allows pharmacies to deliver higher value to patients needing any prescriptions, including opioids.

= Education Topics =

== Educate Parents on Key Points ==

*The most secure way to keep prescription medications is in a locked storage box up and away
*If locking them is not an option keep them stored in a secured place in your home that is up and away from children.
*Keep a medication log so you know what medications you have and how many you have of each medication.
**You should try to do an inventory of all the medicines you have at least once a year, preferably every six months.<ref>http://www.youthconnectionscoalition.org/content/wp-content/uploads/2015/04/safe_storage.pdf</ref>
*Medications whose labels specify that refrigeration is necessary should always be kept in the refrigerator.
*The medicine cabinet in a bathroom is often not the best place to store prescriptions. They should be stored in a cool dry place. Humidity, heat, and the change in temperatures in the bathroom can alter the potency of some medications.<ref>http://www.youthconnectionscoalition.org/content/reduce-rx-abuse-2/the-proper-storage-of-prescription-drugs/</ref> Some storage devices, such as iKeyp, can help protect medications from humidity, even if stored in bathrooms.

= Tools & Resources =

[[TR_-_Improve_Safe_Storage_of_Prescription_Drugs|TR - Increase Safe Storage of Prescription Drugs]]

= Actions to Take =

[[PA_-_Improve_Safe_Storage_of_Prescription_Drugs|Potential Actions and Partners]]

Actions for Individuals

= Resources to Investigate =

[[RTI_-_Improve_Safe_Storage_of_Prescription_Drugs|More RTI on Safe Storage of Prescription Drugs]]<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>

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